TOPLINE:

Youth not in employment, education, or training (NEET) demonstrated nearly double the risk for tobacco use and more than double the risk for cannabis use compared with their non-NEET peers. NEET youth showed a prevalence of tobacco use similar to employed youth but more than triple the rate of students; however, cannabis use was higher among NEET youth than among both the comparison groups.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of observational studies examining tobacco and cannabis use among NEET youth aged 15-29 years, with eligible studies published between 1999 and 2025 across various databases.
• A total of 25 studies involving 91,085 individuals were included, of whom 20,266 were young people with NEET status and 70,819 were participants for comparison from the general population, employed youth, and student groups.
• The analysis examined variations in substance use among NEET profiles to compare those in NEET youth against employed youth, students, and control individuals from the general population using random-effects models.
• Current tobacco use was defined as current smoking (daily or someday smoker); current cannabis use was defined as consumption in the past month or past 3 months; and cannabis use disorder (CUD) was defined as the presence of clinically significant impairment or distress within the past 12 months according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria.
• Sensitivity analyses were conducted on the basis of study quality, and subgroup analyses stratified results on the basis of sex and type of comparison population to investigate potential sources of heterogeneity (measured as I²).

TAKEAWAY:

• NEET status demonstrated a significant association with both current tobacco use (odds ratio [OR], 1.92; 95% CI, 1.46-2.53; I² = 97%) and current cannabis use (OR, 2.14; 95% CI, 1.68-2.71; I² = 53%) compared with non-NEET status.
• The prevalence of current smoking was significantly higher among NEET youth than among students (OR, 3.05; 95% CI, 2.31-4.03; I² = 82%) but showed no statistically significant difference compared with young workers (OR, 1.10; 95% CI, 0.91-1.34; I² = 92%).
• NEET youth exhibited significantly higher levels of cannabis use than both students (OR, 1.81; 95% CI, 1.34-2.44; I² = 42%) and young workers (OR, 1.67; 95% CI, 1.21-2.31; I² = 41%).
• The prevalence of CUD was higher among NEET youth than among non-NEET peers (31.93% vs 12.12%); however, the meta-analysis revealed no statistically significant association (OR, 2.89; 95% CI, 0.42-19.91), with substantial heterogeneity observed (I² = 92%).

IN PRACTICE:

"The substantial variation in substance use prevalence across different NEET profiles underscores that youth with NEET status represent a heterogeneous population requiring differentiated prevention approaches rather than one-size-fits-all interventions," the authors wrote.

"Prevention should be considered part of a comprehensive and integrated approach to health, taking into account individual factors as well as the collective and environmental factors that can be addressed," they added.

SOURCE:

This study was led by Clara Eyraud, Université Paris Cité, Paris, France. It was published online on June 01, 2026, in Addiction.

LIMITATIONS:

The study was limited by substantial statistical heterogeneity across the included literature (I² ranging from 53% to 97%), reflecting varying methodologies, population characteristics, and geographical contexts. Further constraints included the reliance on crude ORs due to heterogeneous adjustment factors; potential measurement bias from self-reported questionnaires focusing solely on quantity; insufficient data for comprehensive analyses of CUD, sex-stratified cannabis outcomes, or polysubstance use patterns; and limited available information regarding group composition and the diversity of existing profiles.

DISCLOSURES:

This study was funded by the French National Cancer Institute (Institut National du Cancer) and the Public Health Research Institute (Institut de Recherche en Santé Publique). The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.